Progress in reaching the United Nations (U.N.) Millennium Development Goal of reducing child mortality two thirds by 2015 is lagging badly. As of 2005 only 32 of 147 developing countries are on track to reach this goal. In 23 countries child mortality has either remained unchanged or risen. And only 2 of the World Bank’s 35 fragile states are on track to meet this goal by 2015.

Along with the eradication of hunger, ensuring access to a safe and reliable supply of water for the estimated 1.1 billion people who lack it is essential to better health for all. The realistic option in many cities now may be to bypass efforts to build costly water-based sewage removal and treatment systems and to opt instead for water-free waste disposal systems that do not disperse disease pathogens. This switch would help alleviate water scarcity, reduce the dissemination of disease agents in water systems, and help close the nutrient cycle-a win-win-win situation.

One of the most impressive health gains has come from a campaign initiated by a little-heralded nongovernmental group in Bangladesh, BRAC, that taught every mother in the country how to prepare oral rehydration solution to treat diarrhea at home by simply adding salt and sugar to water. BRAC succeeded in dramatically reducing infant and child deaths from diarrhea in a country that was densely populated, poverty-stricken, and poorly educated.

Seeing this great success, UNICEF used BRAC’s model for its worldwide diarrheal disease treatment program. This global administration of a remarkably simple oral rehydration technique has been extremely effective-reducing deaths from diarrhea among children from 4.6 million in 1980 to 1.6 million in 2006. Few investments have saved so many lives at such a low cost.

The war against infectious diseases is being waged on a broad front. Perhaps the leading privately funded life-saving activity in the world today is the childhood immunization program. In an effort to fill the gap in this global program, the Bill and Melinda Gates Foundation invested more than $1.5 billion through 2006 to protect children from infectious diseases like measles. Additional investment can help the many countries that cannot afford vaccines for childhood diseases and are falling behind in their vaccination programs. Lacking the funds to invest today, these countries pay a far higher price tomorrow. There are not many situations where just a few pennies spent per youngster can make as much difference as vaccination programs can.

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